Platelet-Rich Plasma Injections in the Treatment of Chronic Rotator Cuff Tendinopathy A Randomized Controlled Trial With 1-Year Follow-up
TL;DR: At 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.
Abstract: Background:Rotator cuff tendinopathy (RCT) is a significant source of disability and loss of work. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of RCT.Purpose:To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic were included in this placebo-controlled, double-blind randomized clinical trial. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week sta...
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TL;DR: Reporting of PRP preparation protocols in clinical studies is highly inconsistent, and the majority of studies did not provide sufficient information to allow the protocol to be reproduced, which does not enable comparison of the PRP products being delivered to patients.
Abstract: Background:Platelet-rich plasma (PRP) is a blood-derived preparation whose use has grown exponentially in orthopaedic practice. However, there remains an unclear understanding of the biological properties and effects of PRP on musculoskeletal healing. Heterogeneous processing methods, unstandardized
295 citations
TL;DR: The clinical results of this study suggest IA PRP and HA treatment for all stages of knee OA, and multiple (3) PRP injections are useful in achieving better clinical results for patients with early OA.
Abstract: To compare the effectiveness of intraarticular (IA) multiple and single platelet-rich plasma (PRP) injections as well as hyaluronic acid (HA) injections in different stages of osteoarthritis (OA) of the knee. A total of 162 patients with different stages of knee OA were randomly divided into four groups receiving 3 IA doses of PRP, one dose of PRP, one dose of HA or a saline injection (control). Then, each group was subdivided into two groups: early OA (Kellgren–Lawrence grade 0 with cartilage degeneration or grade I–III) and advanced OA (Kellgren–Lawrence grade IV). The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores. Adverse events and patient satisfaction were recorded. There was a statistically significant improvement in the IKDC and EQ-VAS scores in all the treatment groups compared with the control group. The knee scores of patients treated with three PRP injections were significantly better than those patients of the other groups. There was no significant difference in the scores of patients injected with one dose of PRP or HA. In the early OA subgroups, significantly better clinical results were achieved in the patients treated with three PRP injections, but there was no significant difference in the clinical results of patients with advanced OA among the treatment groups. The clinical results of this study suggest IA PRP and HA treatment for all stages of knee OA. For patients with early OA, multiple (3) PRP injections are useful in achieving better clinical results. For patients with advanced OA, multiple injections do not significantly improve the results of patients in any group. I.
284 citations
TL;DR: There is good evidence to support the use of a single injection of LR-PRP under ultrasound guidance in tendinopathy, and both the preparation and intratendinous injection technique of PRP appear to be of great clinical significance.
Abstract: Background:Tendinopathy is very common in the general population. There are increasing numbers of clinical studies referring to platelet-rich plasma (PRP) and platelet-poor plasma (PPP) as treatments for tendinopathy.Purpose:To perform a meta-analysis of the outcomes of the PRP groups by preparation method and injection technique in tendinopathy. To determine the clinical effectiveness of the preparations and to evaluate the effect of controls used in the studies reviewed.Study Design:Systematic review and meta-analysis.Methods:The PubMed, EMBASE, CINAHL, and Medline databases were searched in March 2012, April 2014, and August 2015, and randomized controlled trials using autologous blood, PRP, PPP, or autologous conditioned plasma in tendinopathy with outcome measures of pain and follow-up time of 3 months were included in this review. Trials including surgery, tendon tears, and muscle or ligament injuries were excluded. Study quality was assessed using the Cochrane Collaboration risk-of-bias tool by 2 r...
244 citations
TL;DR: Evidence of its efficacy has been highly variable depending on the specific indication, and additional high-quality clinical trials with longer follow-up will be critical in shaping the perspective of this treatment option.
Abstract: This review evaluates current clinical literature on the use of platelet-rich plasma (PRP), including leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP), in order to develop evidence-based recommendations for various musculoskeletal indications. Abundant high-quality evidence supports the use of LR-PRP injection for lateral epicondylitis and LP-PRP for osteoarthritis of the knee. Moderate high-quality evidence supports the use of LR-PRP injection for patellar tendinopathy and of PRP injection for plantar fasciitis and donor site pain in patellar tendon graft BTB ACL reconstruction. There is insufficient evidence to routinely recommend PRP for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains. Current evidence demonstrates a lack of efficacy of PRP for Achilles tendinopathy, muscle injuries, acute fracture or nonunion, surgical augmentation in rotator cuff repair, Achilles tendon repair, and ACL reconstruction. PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.
209 citations
TL;DR: Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation.
Abstract: Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied. A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons. The following inclusion criteria for relevant articles were used: clinical trials written in English language up to 21 June 2016 on the use of PRP in the conservative or surgical treatment of the aforementioned tendinopathies. The research identified the following clinical trials dealing with the application of PRP in the selected tendons: 19 papers on patellar tendon (6 being RCTs: 4 dealing with PRP conservative application and 2 surgical), 24 papers on Achilles tendon (4 RCTs: 3 conservative and 1 surgical), 29 on lateral elbow tendons (17 RCTs, all conservative), and 32 on rotator cuff (22 RCTs: 18 surgical and 3 conservative). Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation. Lateral elbow tendinopathy showed an improvement in most of the high-level studies, but the lack of proven superiority with respect to the more simple whole-blood injections still questions its use in the clinical practice. With regard to rotator cuff pathology, the vast majority of surgical RCTs documented a lack of beneficial effects, whereas there is still inconclusive evidence concerning its conservative application in rotator cuff disorders. Systematic review of level I–IV trials, Level IV.
159 citations
Cites background from "Platelet-Rich Plasma Injections in ..."
...AM J SPORT MED 2013 [57] Level I Randomized controlled trial 40 pa ents: n=20 PRP...
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...[57] reported no differences in clinical scores and...
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References
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TL;DR: The definition of PRP, its safety, its proper development, and its most efficacious means of application are discussed.
Abstract: P l atelet-rich plasma (PRP) has been a breakthrough in the stimulation and acceleration of bone and soft tissue healing. It represents a relatively new biotechnology that is part of the growing interest in tissue engineering and cellular therapy today. Because of its newness, there is a potential for misunderstanding, misuse, and application of what the practitioner may incorrectly think is PRP. The purpose of this paper is to discuss the definition of PRP, its safety, its proper development, and its most efficacious means of application.
1,357 citations
TL;DR: High negative correlations between changes in SPADi scores and changes in shoulder ROM indicated the SPADI detected changes in clinical status over short time intervals, and should prove useful for both clinical and research purposes.
Abstract: A shoulder pain and disability index (SPADI) was developed to measure the pain and disability associated with shoulder pathology. The SPADI is a self-administered index consisting of 13 items divided into two subscales: pain and disability. Thirty-seven male patients with shoulder pain were used in a study to examine the measurement characteristics of the SPADI. Test-retest reliability of the SPADI total and subscale scores ranged from 0.6377 to 0.6552. Internal consistency ranged from 0.8604 to 0.9507. SPADI total and subscale scores were highly negatively correlated with shoulder range of motion (ROM) supporting the criterion validity of the index. Principal components factor analysis with and without varimax rotation supported the construct validity of the total SPADI and its subscales. High negative correlations between changes in SPADI scores and changes in shoulder ROM indicated the SPADI detected changes in clinical status over short time intervals. The SPADI should prove useful for both clinical and research purposes.
910 citations
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...5 (0-75) Placebo 90 (60-100) 65 (10-90) 35 (10-100) 35 (3-100) 40 (1-100) 10 (0-100) Flexion, deg PRP 180 (90-180) 180 (110-180) 180 (140-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (80-180) 180 (90-180) 180 (100-180) 180 (100-180) 180 (120-180) 180 (140-180) Abduction, deg PRP 180 (70-180) 180 (70-180) 180 (90-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (70-180) 180 (80-180) 180 (90-180) 180 (90-180) 180 (100-180) 180 (110-180) IR, deg PRP 60 (0-90) 90 (30-90) 90 (60-90) 90 (50-90) 90 (50-90) 90 (70-90) Placebo 70 (0-90) 90 (10-180) 90 (30-180) 90 (30-180) 90 (40-180) 90 (60-90) ER, deg PRP 90 (40-90) 90 (50-90) 90 (80-90) 90 (80-90) 90 (80-90) 90 (90-90) Placebo 90 (0-180) 90 (20-180) 90 (40-180) 90 (40-180) 90 (50-180) 90 (50-90)...
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...0) VAS PRP 80 (60-100) 50 (10-100) 40 (5-80) 30 (0-100) 25 (0-90) 7....
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TL;DR: Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation and should be considered before surgical intervention.
Abstract: BackgroundElbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention.HypothesisTreatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem.Study DesignCohort study; Level of evidence, 2.MethodsOne hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma ...
876 citations
Additional excerpts
...5 (0-75) Placebo 90 (60-100) 65 (10-90) 35 (10-100) 35 (3-100) 40 (1-100) 10 (0-100) Flexion, deg PRP 180 (90-180) 180 (110-180) 180 (140-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (80-180) 180 (90-180) 180 (100-180) 180 (100-180) 180 (120-180) 180 (140-180) Abduction, deg PRP 180 (70-180) 180 (70-180) 180 (90-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (70-180) 180 (80-180) 180 (90-180) 180 (90-180) 180 (100-180) 180 (110-180) IR, deg PRP 60 (0-90) 90 (30-90) 90 (60-90) 90 (50-90) 90 (50-90) 90 (70-90) Placebo 70 (0-90) 90 (10-180) 90 (30-180) 90 (30-180) 90 (40-180) 90 (60-90) ER, deg PRP 90 (40-90) 90 (50-90) 90 (80-90) 90 (80-90) 90 (80-90) 90 (90-90) Placebo 90 (0-180) 90 (20-180) 90 (40-180) 90 (40-180) 90 (50-180) 90 (50-90)...
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...0) VAS PRP 80 (60-100) 50 (10-100) 40 (5-80) 30 (0-100) 25 (0-90) 7....
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TL;DR: Although the patient characteristics of specific disorders showed some similarities with the clinical pictures described in the literature, further research is required to demonstrate whether the proposed syndromes indeed constitute separate disorders with a different underlying pathology, requiring different treatment strategies.
Abstract: OBJECTIVES--To study the incidence and management of intrinsic shoulder disorders in Dutch general practice, and to evaluate which patient characteristics are associated with specific diagnostic categories. METHODS--In 11 general practices (35,150 registered patients) all consultations concerning shoulder complaints were registered during a period of one year. Patients with an intrinsic shoulder disorder who had not consulted their general practitioner for the complaint during the preceding year (incident cases) were asked to participate in an observational study. Participants completed a questionnaire regarding the nature and severity of their complaints. The general practitioners recorded data on diagnosis and therapy. RESULTS--The cumulative incidence of shoulder complaints in general practice was estimated to be 11.2/1000 patients/year (95% confidence limits 10.1 to 12.3). Rotator cuff tendinitis was the most frequently recorded disorder (29%). There were 349 incident cases enrolled in the observational study. Patient characteristics showed small variations between different diagnostic categories. Age, duration of symptoms, precipitating cause and restriction of movement seemed to be discriminating factors. Twenty two percent of all participants received injections during the first consultation; most (85%) were diagnosed as having bursitis. The majority of patients with tendinitis (53%) were referred for physiotherapy. CONCLUSION--With respect to diagnosis and treatment, the practitioners generally appeared to follow the guidelines issued by the Dutch College of General Practitioners. Although the patient characteristics of specific disorders showed some similarities with the clinical pictures described in the literature, further research is required to demonstrate whether the proposed syndromes indeed constitute separate disorders with a different underlying pathology, requiring different treatment strategies.
864 citations
Additional excerpts
...5 (0-75) Placebo 90 (60-100) 65 (10-90) 35 (10-100) 35 (3-100) 40 (1-100) 10 (0-100) Flexion, deg PRP 180 (90-180) 180 (110-180) 180 (140-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (80-180) 180 (90-180) 180 (100-180) 180 (100-180) 180 (120-180) 180 (140-180) Abduction, deg PRP 180 (70-180) 180 (70-180) 180 (90-180) 180 (160-180) 180 (160-180) 180 (170-180) Placebo 180 (70-180) 180 (80-180) 180 (90-180) 180 (90-180) 180 (100-180) 180 (110-180) IR, deg PRP 60 (0-90) 90 (30-90) 90 (60-90) 90 (50-90) 90 (50-90) 90 (70-90) Placebo 70 (0-90) 90 (10-180) 90 (30-180) 90 (30-180) 90 (40-180) 90 (60-90) ER, deg PRP 90 (40-90) 90 (50-90) 90 (80-90) 90 (80-90) 90 (80-90) 90 (90-90) Placebo 90 (0-180) 90 (20-180) 90 (40-180) 90 (40-180) 90 (50-180) 90 (50-90)...
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...0) VAS PRP 80 (60-100) 50 (10-100) 40 (5-80) 30 (0-100) 25 (0-90) 7....
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...659 External rotation 90 (40-90) 90 (0-180) ....
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TL;DR: Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity, and was not significantly different between both groups.
Abstract: Context Tendon disorders comprise 30% to 50% of all activity-related injuries; chronic degenerative tendon disorders (tendinopathy) occur frequently and are difficult to treat. Tendon regeneration might be improved by injecting platelet-rich plasma (PRP), an increasingly used treatment for releasing growth factors into the degenerative tendon. Objective To examine whether a PRP injection would improve outcome in chronic midportion Achilles tendinopathy. Design, Setting, and Patients A stratified, block-randomized, double-blind, placebo-controlled trial at a single center (The Hague Medical Center, Leidschendam, the Netherlands) of 54 randomized patients aged 18 to 70 years with chronic tendinopathy 2 to 7 cm above the Achilles tendon insertion. The trial was conducted between August 28, 2008, and January 29, 2009, with follow-up until July 16, 2009. Intervention Eccentric exercises (usual care) with either a PRP injection (PRP group) or saline injection (placebo group). Randomization was stratified by activity level. Main Outcome Measures The validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which evaluated pain score and activity level, was completed at baseline and 6, 12, and 24 weeks. The VISA-A score ranged from 0 to 100, with higher scores corresponding with less pain and increased activity. Treatment group effects were evaluated using general linear models on the basis of intention-to-treat. Results After randomization into the PRP group (n = 27) or placebo group (n = 27), there was complete follow-up of all patients. The mean VISA-A score improved significantly after 24 weeks in the PRP group by 21.7 points (95% confidence interval [CI], 13.0-30.5) and in the placebo group by 20.5 points (95% CI, 11.6-29.4). The increase was not significantly different between both groups (adjusted between-group difference from baseline to 24 weeks, −0.9; 95% CI, −12.4 to 10.6). This CI did not include the predefined relevant difference of 12 points in favor of PRP treatment. Conclusion Among patients with chronic Achilles tendinopathy who were treated with eccentric exercises, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity. Trial Registration clinicaltrials.gov Identifier: NCT00761423
784 citations